Interview: Radiology in the Czech Republic

Please tell us how you came to work in medical imaging.

I come from a family of physicians. My father was a neurologist, my mother was a paediatrician and adolescent physician, my uncle was an ORL specialist, my aunt was a paediatrician and another aunt of mine was a gynaecologist. It was rather a given fact, then, that my future studies would be at the faculty of medicine. Along with the faculty of medicine I studied technology, which, among other things, directed my interest towards radiology, which I had already practiced as a student. Upon graduating in 1985, I started working at a radiology department. In 1986, after one year of military service, I started working at the radiology clinic at St. Anne's University Hospital Brno. In 2001, I became the head of that clinic. Since the beginning of my professional career I have been committed to abdominal and gastrointestinal radiology. In 1988, I performed the first enteroclysis in the Czech Republic. After 1989, I extended my area of interest to non-vascular interventions and oncological radiology, including interventional radiology. The radiology clinic at the Faculty Hospital Brno is now the leading department in these areas in the Czech Republic and Slovakia.

Are You Involved Professionally With International Societies for Radiology?

Yes, I am a member of several professional societies – ECR, RSNA, ARRS, CIRSE, ESGAR, SGR and others. I am also a representative of the Czech Radiology Society in some of these societies.

Please Give Us an Overview of the Department of Radiology in Which You Work.

The University Hospital Brno (UHB) competes with University Hospital Motol in Prague for the position as the largest hospital in the Czech Republic. The UHB currently has four CT units and three for magnetic resonance. It is fully digitised and we have had PACS for the last 10 years. Our hospital performs a comprehensive range of radiology procedures, including radiology interventions, neuroradiology and mammography screening.

Our hospital has 2,280 beds. Each year it attends to some 38,000 patients and nearly 1,100,000 outpatients. In our hospital there are two separate radiology departments: the radiology clinic and the children's radiology department, the latter of which is located in a separate children's hospital that is organisationally part of UHB. At the radiology clinic, we attend to around 130,000 patients a year who undergo some 220,000 examinations.

Are Sufficient Numbers of Medical Residents Attracted to Radiology in the Czech Republic?

There are around 1,500 radiologists in the Czech Republic, and every year some 30 radiologists receive their certifications. Preparation takes five years, which means that about 150 radiologists are in preparation at any given time. A number of the physicians go abroad after receiving their certifications. Around 45 radiologists have to be certified each year so that their numbers do not decrease. An issue, however, is just how many radiologists are really needed. From the market point of view, radiologists are in constant demand both abroad and in the Czech Republic. The Czech Republic even has leading positions that are vacant, including positions for heads of clinics. To satisfy the demand, another 300 radiologists would be needed in the Czech Republic.

Would You Say That Medical Imaging is Adequately Financially Compensated as a Profession in the Czech Republic in Comparison With Other European Countries?

Of course it is not. The salary is very difficult to determine and estimate. Generally, we can say that a basic physician's gross monthly salary is around CZK 20,000 (EUR 810), and a specialised physician's salary depends on the length of his or her work experience. The average salary of a physician who works 40 hours a week and is on call four times per week (from 2 p.m. to 7 a.m. the next day) and has one weekend duty (24 hours on Saturday or Sunday), who is 40 years old, has full qualifications and is not in the position of a chief physician or head of a clinic is around CZK 30,000 – 50,000 (EUR 1,200 – 2,025) gross, including all benefits, extra allowances and bonuses. In the private sector this can reach CZK 60,000 – 90,000 (EUR 2,430 – 3,645) per month. The maximum salary in radiology can be around CZK 100,000 – 150,000 (EUR 4,050 – 6,075) gross per month. This is one of the reasons why younger physicians in particular are interested in working abroad.

Is Continuing Education Important for Radiologists in the Czech Republic After Mandatory Training is Complete?

Continuing education in radiology is important mainly for physicians who have private practices and their own offices. Physicians have to earn so-called credits, which are assigned to individual events by the Czech Medical Chamber. The number of credits is a condition for obtaining a licence. All of this is relatively benevolent, but the interest in congresses and courses in the Czech Republic is immense. The national congress is regularly attended by around 600 – 700 radiologists and there are a number of events that have 200 – 300 participants on average. Virtually all events attract more people than their capacity allows. Educational events are coordinated by the committee of the Czech Radiology Society, which assigns them with a "quality certificate". Apart from the national congress, which is held once every two years, there are two national events in interventional radiology each year, a three-day MR course, a one-week MR and CT course, a CT school for young physicians, a threeday ultrasound congress, a neuroradiology congress, a paediatric radiology congress, an abdominal and gastrointestinal radiology congress, and several other events. All the aforementioned congresses are mainly educational and most communications are in the form of invited lectures.

Are There Any Dedicated Management or Administration Courses Taught to Radiology Students?

There are no such courses. There are, however, MBA courses focused on healthcare, and there is also an annual meeting of senior physicians from radiology departments.

What are the Main Management Challenges You Experience in Your Working Life?

In my opinion, the major issue is the large number of socalled "large radiology departments" in the Czech Republic. There are 10 radiology clinics and another six departments have clinic status (which means they are connected to faculties of medicine). In addition, there are seven other large departments in regional hospitals. These 23 departments would like to be the equivalent of large departments abroad in terms of the number of their procedures. A large radiology department in the Czech Republic, however, has not more than 30 physicians, including residents, and very rarely is there more than one associate professor or a professor. Moreover, in most such departments there are no academic workers. The publication activity of these departments is very low or nonexistent. To establish a large radiology department on a par with large departments abroad is thus absolutely impossible.

The quality of radiology – and by that I mean practical radiology – is high, but the quality of research, science and experimental work is low. The typical budget of a large department is around CZK 4,500,000 (EUR 182,000) per month. This money is used for purchasing contrast agents and the usual materials that are necessary day to day, including instrumentation. That considerably limits the ability to perform costly procedures. Thus, from an economic viewpoint, the running of a radiology clinic – and that is fully within the competence of the head of a clinic – is a big challenge and a difficult task.

As the concentration of large departments is high, these departments also have rather small geographic areas that they naturally serve. There are in the Czech Republic, I estimate, around 20 radiology departments whose management is convinced they do quality radiology within the whole range of procedures, including interventions. These departments thus have natural service areas of around 500,000 inhabitants, considering that the population of the Czech Republic is 10,000,000.

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